可手术Ⅲ期乳腺癌术前新辅助化疗的临床疗效

目的探讨乳腺癌新辅助化疗CTFP方案的疗效和不良反应。方法接受CTFP方案新辅助化疗的58例经病理证实的乳腺癌患者,给予术前化疗4周期。每周期用药：环磷酰胺（CTX）500 mg/m2,第1天;吡柔比星（THP）50 mg/m2,第1天;氟尿嘧啶（5-Fu）500 mg/m2,第1天;顺铂（DDP）80 mg/m2,第1天。结果完全缓解（CR）10例,占17.2%;部分缓解（PR）39例,占67.2%,总有效率（CR＋PR）为84.4%;进展（PD）3例,占5.2%。经过2个周期化疗后观察疗效不满意即中转手术治疗。结论乳腺癌新辅助化疗CTFP方案疗效肯定,中晚期病例在化疗期间应认真观察病情变化,若疗效不满意应果断中转手术治疗。CTFP方案化疗主要不良反应是恶心、呕吐、脱发、白细胞低下等,经过对症治疗后患者可以耐受。     

可手术乳腺癌新辅助化疗近期疗效观察

目的 研究可手术乳腺癌患者手术前给予新辅助化疗(NCT)的安全性、近期疗效以及对手术方式的影响。方法 我院于1997年3月～2001年12月收治的224例可手术乳腺癌患者(Ⅱ～Ⅲ期)术前随机给予CMF(CTX+MIX+5-Fu)方案或CAF(CTX+ADM+5-Fu)方案化疗两个周期,全部患者治疗前均经针吸细胞学检查确诊,评价其近期疗效和毒性反应,将临床原发肿瘤对化疗的反应按WHO标准分为完全缓解(CR)、部分缓解(PR)、无效(NR)或进展(PD)。结果 全部224例化疗患者中,CR 17例,PR 136例,总有效率68.3％,无恶化病例;毒性反应主要表现为胃肠道反应和骨髓抑制。胃肠道反应主要表现为恶心、呕吐,其中Ⅱ～Ⅲ级为65.6％;骨髓抑制以白细胞减少为主,Ⅲ～Ⅳ级白细胞减少发生率为60.3%,经对症治疗后均可缓解。全部患者无因为化疗的毒性反应而终止治疗的病例。结论 对于可手术乳腺癌的患者手术前给予新辅助化疗(NCT)可以使原发灶明显缩小,能够为预测化疗效果提供实体依据,降低手术复杂性,缩小手术范围,提高患者术后的生活质量,并且安全可行,是一种提高治疗效果的重要治疗方法。     

Ⅲ期乳腺癌新辅助化疗20例临床观察

20例Ⅲ期乳腺癌进行新辅助化疗,化疗方案为CAF或CEF,疗程均为3个周期,术后再根据病情和术前化疗结果辅以放疗及辅助化疗。原发灶PR16例(16/20),SD4例(4/20),有效率80%。腋窝淋巴结CR1例,PR18例,有效率95%。术后随访4~35个月,平均12个月,无死亡病例。     

EC与CEF方案用于乳腺癌新辅助化疗临床观察

[目的]对比观察EC(表阿霉素 环磷酰胺)与CEF(环磷酰胺 表阿霉素 氟尿嘧啶)方案用于乳腺癌新辅助化疗的疗效及毒副反应.[方法]64例经病理组织学或细胞学证实的Ⅱ、Ⅲa期乳腺癌患者随机分为两组,EC组30例,表阿霉素75mg/m2静滴d1,环磷酰胺600mg/m2,d1,每2周重复;CEF组34例,环磷酰胺500mg/m2,d1,表阿霉素60mg/m2静滴d1,氟尿嘧啶500mg/m2静滴d1,8每3周重复.[结果]EC组CEF组的有效率分别为73.3%和76.5%,两组间差异无显著性(P＞0.05).两组不良反应也无显著性差异.[结论]EC方案和CEF方案用于乳腺癌新辅助化疗均有较高的疗效,EC方案能缩短术前化疗时间,避免延迟手术时机.     

可手术乳腺癌的新辅助全身治疗

新辅助全身治疗(neoadjuvant systemic treatment, NST)也称术前全身治疗。以全身治疗为原发性乳腺癌的首治方法兴起于上世纪70年代,其初衷是为了解决不可切除或切除困难的局部晚期乳腺癌(locally advanced breast cancer,LABC)和炎性乳腺     

可手术乳腺癌新辅助化疗的临床分析

目的 探讨新辅助化疗对可手术乳腺癌治疗的作用及与生物学指标的关系。方法 分析84例新辅助化疗的乳腺癌患者,治疗前对原发灶用TSK stericut针穿刺活检并用免疫组化法检测ER、PR、CerbB-2、p53,所有患者采用CEF（环磷酰胺＋表阿霉素＋氟脲嘧啶,每3周1次）或TE（表阿霉素＋泰素或泰素帝,每3周1次）方案化疗2～4个周期,化疗后1～2周手术。疗效以原发灶B超检查两径乘积变化按UICC实体瘤疗效评定标准进行评估。结果 TE方案有效率（80.6%）高于CEF方案（56.6%）,CerbB-2阴性者的有效率（75.0%）较阳性者（52.8%）高,p53阳性者有效率（77.5%）高于阴性者（54.5%）,P均〈0.05。多因素分析显示,TE方案、p53阳性独立地与新辅助化疗有效率相关。结论 新辅助化疗在乳腺癌综合治疗中有重要的作用。TE方案、p53阳性者具有较高的缓解率。活检针穿刺可用于乳腺癌的术前病理诊断并测定生物学指标。     

23例Ⅲ及Ⅳ期乳腺癌CTF方案新辅助化疗的临床分析

目的分析和探讨乳腺癌新辅助化疗临床疗效及毒副反应。方法全组23例均采用以吡柔比星（THP）为主的CTF（CTX＋THP＋5-Fu）方案，每21d为1周期，接受2—3周期化疗后进行评价。结果14例Ⅲ期乳腺癌有效率为92．86％，9例Ⅳ期乳腺癌有效率为66．67％，Ⅲ、Ⅳ期总有效率为82．61％。毒副反应相对较轻。结论以THP为主的CTF新辅助化疗方案效果肯定，毒副作用小，值得临床应用和推广。     

以吡柔比星为主的新辅助化疗结合手术治疗乳腺癌的临床观察

目的探讨乳腺癌新辅助化疗的可行性和不良反应。方法45例乳腺癌患者接受以吡柔比星（THP）50mg/m^2为主的术前化疗2个周期,化疗结束后5～7 d天再予手术（试验组）。39例乳腺癌患者同期直接手术（对照组）。结果试验组化疗总有效率为77.7%（35/45）;两组的手术难度、手术时间、术中出血量及术后引流量差异均无显著性（P〉0.05）。结论对可手术乳腺癌患者行术前新辅助化疗可使原发病灶缩小,减少手术范围,提高患者术后生活质量;不增加手术并发症,可望提高疗效。     

新辅助化疗CTFci方案治疗乳腺癌82例疗效观察

[目的]观察CTFci（CTX、THP、5-Fu）方案在乳腺癌新辅助化疗中的疗效和不良反应。[方法]82例Ⅱ～Ⅲ期乳腺癌采用CTFci方案行新辅助化疗,环磷酰胺（CTX）500mg/m2,静脉滴注d1、8;吡柔比星（THP）35mg/m2,静脉滴注d1、8;氟尿嘧啶（5-Fu）采用锁骨下静脉穿刺置管,便携式微型泵持续小剂量输注,每天200mg/m2,d1～28。[结果]总有效率为85.4%,其中临床完全缓解（cCR）率28.0%,病理学完全缓解（pCR）率17.1%。主要不良反应为胃肠道反应、骨髓抑制和脱发,患者均能耐受。[结论]CTFci方案在乳腺癌新辅助化疗中疗效较好,不良反应可耐受。     

可手术乳腺癌新辅助化疗364例临床分析

目的：探讨新辅助化疗对可手术乳腺癌的治疗作用、方案、周期数以及生物学指标与疗效的关系。方法：364例新辅助化疗的乳腺癌患者,治疗前肿瘤穿刺活检或术后标本均检测生物学指标ER、PR、C-erbB-2、Ki-67、p53。患者采用FAC、TE、NP方案化疗,每3～4周1次,共1～4个周期,化疗结束后10～14天手术。疗效按UICC实体瘤疗效评定标准进行评价,并统计患者5年生存率。结果：TE方案有效率及病理缓解率高于FAC方案及NP方案（P〈0．05）,其5年生存率也高于后两方案（P〈0．05）;新辅助化疗2周期以上的有效率高于2个周期（P〈0．05）,但平均生存时间无显著差异（P〉0．05）;C-erbB-2阴性、p53阳性、ER／PR阴性患者的有效率高（P〈0．05）;Ki-67表达结果不影响治疗的有效率（P〉0．05）;以上生物学指标表达的不同情况5年生存率之间无显著差异（P〉0．05）。结论：可手术乳腺癌术前应给予2个周期以上TE方案化疗;生物学指标中C-erbB-2阴性、p53阳性、ER／PR阴性的患者有效率高。     

Neoadjuvant chemotherapy for operable breast cancer

Adjuvant systemic chemotherapy has been shown to prolong survival in all subsets of patients with breast cancer. In addition, among patients with locally advanced breast cancer, neoadjuvant orpreoperative chemotherapy has improved the ability to perform breast-conserving therapy. This observation, combined with multiple preclinical hypotheses and the results of laboratory studies, has prompted investigation of neoadjuvant chemotherapy as a treatment strategy for operable breast cancer. In this article, both the evidence supporting this treatment approach and some of the problems associated with it are reviewed. Currently, seven randomized studies comparing neoadjuvant chemotherapy followed by surgery or surgery followed, in turn, by adjuvant chemotherapy have been completed and their results analyzed. Despite exciting preclinical evidence, no trial to date has shown a survival advantage for the neoadjuvant treatment approach. Nonetheless, evidence from more recent phase III trials and the fact that neoadjuvant chemotherapy is not harmful topatients validate its use in operable breast cancer.     

Neoadjuvant chemotherapy in operable breast cancer

Primary chemotherapy in localised breast cancer may prevent tumour spread during surgical treatment and reduce proliferation of micrometastases. A randomised clinical trial, in 196 premenopausal and postmenopausal patients with operable (T2-3, N0-1b) breast cancer, was started in November 1983 at the Institut Curie to compare neoadjuvant and adjuvant regimens of chemotherapy with radiotherapy with or without surgery. The patients have been followed up for 35–70 months (median 54). A neoadjuvant group received two monthly cycles of intravenous doxorubicin/cyclophosphamide/5-fluorouracil before locoregional therapy and four cycles subsequently. Six months cycles following locoregional therapy were administered to the adjuvant group. Because of inclusion of postmenopausal and/or node-negative patients, compliance was less than optimal in 39 patients who were analysed separately according to actual dose received. Tumour response, evaluated after two cycles of neoadjuvant chemotherapy, was significantly associated with dose (P = 0.003). Survival showed a slight non-significant advantage for the neoadjuvant group. Survival plotted by actual dose was also similar. Neoadjuvant chemotherapy was safe and at least as effective as the adjuvant regimen. Patients have been accrued to a subsequent larger trial of chemotherapy as first-line treatment.     

原发性乳腺癌新辅助化疗的临床研究

目的　探讨以 5 氟脲嘧啶 (5 Fu)和蒽环类药物为主的联合化疗对原发性乳腺癌新辅助化疗的应用价值。方法　 111例患者的 114个原发性乳腺癌 ,于手术前应用 5 Fu和蒽环类药物 (吡柔比星或表柔比星 )为主的联合化疗 2～ 6个周期 ,观察其疗效和毒副反应 ,并分析疗效与肿瘤特征的关系。结果　全组总有效率为 87.7% ,其中临床完全缓解率为 39.5 % ,病理学完全缓解率为 2 3.7% ,疾病进展率为 0 .9%。吡柔比星方案较表柔比星方案疗效更佳 ,两方案病理学完全缓解者差异有显著性 (P <0 .0 5 )。吡柔比星方案的脱发反应轻微 ,但骨髓抑制较表柔比星方案严重。肿瘤激素受体表达与疗效有关 ,激素受体表达阴性者病理学完全缓解率为 33.3% ,而激素受体表达阳性者仅为 7.5 %(P <0 .0 0 5 )。肿瘤大小和HER 2表达与疗效无关。结论　 5 Fu和蒽环类药物为主的联合方案用于乳腺癌新辅助化疗 ,近期疗效满意 ,且副反应较轻。吡柔比星方案的疗效优于表柔比星方案 ,激素受体表达阴性者对化疗更敏感     

Neo-adjuvant chemotherapy for operable breast cancer induces apoptosis

The use of neo-adjuvant chemotherapy (often referred to as pre-operative or primary chemotherapy) represents a major change in the management of breast cancer as a systemic disease. Laboratory studies have shown that many anti-cancer agents with differing modes of action achieve cytotoxic effects by inducing apoptosis. In this study, we investigated the induction of apoptosis by neo-adjuvant chemotherapy in human breast cancer. The aim was to determine whether a correlation existed between post chemotherapy apoptotic index (AI) and clinical response and patients' survival. Our results indicate that apoptosis is induced by neo-adjuvant chemotherapy and that the response is variable. Our data show that post chemotherapy AI correlated with clinical response and increased patient survival, including both relapse (disease) free survival and overall survival. Post-neo-adjuvant chemotherapy AI levels in primary breast cancer may possibly predict an individual patient's overall response.     

Neoadjuvant chemotherapy in breast cancer

Taking into account what we presently know aboaut neoadjuvant chemotherapyn in breast cancer, the following conclusions may be drawn:     

可手术乳腺癌的新辅助化疗

新辅助化疗已被广泛用于局部晚期乳腺癌,早期可手术乳腺癌的新辅助化疗应用价值还在探讨之中。本文综述了新辅助化疗治疗可手术乳腺癌基础及临床方面的最新进展,认为新辅助化疗应用于早期可手术乳腺癌,可明显消退肿瘤,提高乳房保留治疗率,可获得至少与辅助化疗同样的总生存率。     

可手术的乳腺癌术前化疗的近期临床观察

Eighty-one patients with operable breast cancers received the short-term and intensive preoperative chemotherapy, followed by radical mastectomy are presented. The total response rate in the primary tumor to chemotherapy was 59%. Seven patients (8.6%) had complete remission, 41 (50.6%) partial remission and 33 (40.7%) stable lesions. No cancer cells were found histopathologically by serial sections from two primary lesions after chemotherapy. The authors found that tumor with small size, short course and regular shape had a better response rate. Histopathological type, firmness and boundary of tumor, menopausal status, and estrogen receptor (ER) status were not related to the chemotherapeutic effect. No obvious toxicity and side effects were found during the chemotherapy. The chemotherapy did not influence the wound healing. The results indicate that the chemotherapy has a favorable effect on breast cancer and is safe and valid. The response rate of breast cancer to chemotherapy before operation can be used as breast cancer chemosensitivity test in vivo.     

Neoadjuvant chemotherapy for local advanced breast cancer with stage IIIB

In this study, we have done a retrospective evaluation of the clinical benefits of neoadjuvant chemotherapy in 25 patients with stage IIIB, locally advanced breast cancer in terms of response rate and survival benefit. Most of these patients were treated with an anthracycline-based regimen such as CAF and EC, and some were also treated sequentially with docetaxel. An overall objective response was observed in 15 patients (60%), composed of 1 patient (4%) with a complete response (CR) and 14 (56%) with a partial response (PR). No progressive disease was observed. Following neoadjuvant chemotherapy, locoregional treatment (mastectomy without partial resection) was carried out in 24 patients, 1 of whom also received radiotherapy. The rate of local recurrence in neoadjuvant chemotherapy with anthracycline-based regimens was lower than those of adjuvant chemotherapy with anthracycline-based and non-anthracycline-based regimens (10.0% versus 33.3% and 28.5%, respectively). By contrast, the rate of distant metastasis with neoadjuvant chemotherapy was higher than that seen with anthracycline-based adjuvant chemotherapy regimens (35.0% versus 11.1%, respectively), while the rate of distant metastasis in non-anthracycline-based regimens was even higher at 66.6%. The 5-year survival in the responders treated with neoadjuvant chemotherapy was better than in the non-responders (90.9% versus 50.0%; NS, P=0.28, log-rank test). The survival at 5 years in the patients treated with neoadjuvant chemotherapy was inferior to that with adjuvant anthracycline-based chemotherapy regimens (69.7% versus 77.8%), although the survival in neoadjuvant chemotherapy was better than those of non-anthracycline-based adjuvant regimen (69.7% versus 66.7%). However, at 10 years the overall survival with anthracycline-based neoadjuvant chemotherapy regimens was superior to that seen with either anthracycline or non-anthracycline-based adjuvant chemotherapy regimens. These results suggest that primary (neoadjuvant) systemic therapy with anthracycline-based regimens for locally advanced, stage IIIB, breast cancer may have a potential survival benefit when given in combination with adjuvant chemotherapy, as it will provide the best means of decreasing both local recurrence and distant metastasis.